Provider Demographics
NPI:1356769889
Name:MATOSIAN, CHRISTINE ASHLEY (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ASHLEY
Last Name:MATOSIAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2213
Mailing Address - Country:US
Mailing Address - Phone:203-231-2274
Mailing Address - Fax:
Practice Address - Street 1:350 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1336
Practice Address - Country:US
Practice Address - Phone:203-732-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist